The Illinois Department of Healthcare and Family Services (HFS) has renewed the Illinois
Health Connect Bonus Payment For High Performance program, now in its sixth year.
For the 2013 program, qualifying Illinois Health Connect (IHC) Primary Care Providers (PCPs)
are eligible to receive bonus payments for each qualifying service under the following six
What are the Bonus Measurements?
- Immunization Combo 3: Children who receive designated immunizations by age 24 months (benchmark 71.93%).
- Developmental Screening: Children who receive at least one objective screening by the age of 12 months (benchmark 85%),
between the ages of 12-24 months (benchmark 70%), and between the ages of 24-36 months (benchmark 65%). A bonus will be available
for each separate age group.
- Asthma management: Clients with persistent asthma, ages 5-11 years (benchmark 91.59%), 12-18 years (benchmark 86.96%),
19-50 years (benchmark 75.53%) and ages 51-64 years (benchmark 73.81%) who fill an asthma controller medication prescription. A bonus will
be available for each separate age group.
- Diabetes Management: Clients with diabetes, ages 18-75 years who receive at least one HbA1c test annually (benchmark 82.38%).
- Breast Cancer Screening: Women ages between ages 42-69 who have had a mammogram in the last two years (benchmark 50.46%).
- Lead Screening: Children who receive at least one capillary or venous blood lead test by the age of 24 months (benchmark 71.41%).
Who is a qualifying PCP?
A qualifying PCP is an Illinois Health Connect PCP who meets or exceeds the 2012 HEDIS 50th percentile benchmark collectively for all the
Illinois Health Connect enrollees on their panel roster for a particular measure, or, in the case of developmental screening, the benchmark
target set forth above. A PCP may be a qualifying PCP for one or more measurement.
What is HEDIS?
HEDIS is the Healthcare Effectiveness Data and Information Set, which is a national reporting system administered by the National Committee for
Quality Assurance (NCQA) to measure performance on a number of important measures of care and service. Most commercial health plans and state
Medicaid programs utilize these measures. National benchmarks are reported annually which provide a summary of the various metrics. HFS is using
the 50th percentile (meaning half of all Medicaid plans perform above and half perform below the benchmark) as a minimal threshold of performance.
How will we measure whether you met the benchmark?
HFS will count the number of qualifying clents for each measure enrolled on each PCP’s Illinois Health Connect panel roster on
December 1, 2013. Illinois Health Connect will then look to see which of those clients received the measured service during the measurement period. HFS claims data
will be used to determine whether a service was rendered (for immunizations, ICARE and Cornerstone data will also be used, and IDPH data will
be used for lead screening). Although providers have 180 days from the date of service to bill in order to be paid for the service, the bonus
payment will be based on measurement year 2013 claims, after a three-month run out (January through March of 2014). This means all claims for
measurement year 2013 services must be submitted to HFS prior to April 1, 2014 to be counted. We will then determine and pay the bonus payments in June 2014.
PCPs do not have to report any special information to earn a bonus payment; but they need to submit a detailed claim for the services that are rendered.
A measured service is counted whether or not it was the current PCP or another provider who rendered the service during the measurement period.
We will use the date of service for the measured service to determine if it was rendered in the measurement period. Ordering a service for a client does not
qualify for a bonus payment, the service must actually be received by the client. Please refer to the each bonus measurement link below for details on the
billing codes measured, the time period measured and other details to maximize the opportunity for bonus payments.
For which services will bonus payments be made?
If a PCP meets or exceeds the benchmark for a particular measured service, a bonus payment will be made for each client that received the measured
service. If the PCP does not meet the benchmark, there will be no bonus payment made for any clients, whether they received the service or not.
How much are the bonus payments?
The 2013 bonus payments will be $25 per client per qualifying service. One client may meet several measurements and, therefore, may count
towards more than one qualifying service.
For specific information about each of the clinical measures, click on the links
To view IHC Bonus Payment information from previous years, click on the links below:
(Downloadable file requires Adobe Acrobat Reader - Free Download)